Coagulation PPT- Josh Flashcards
Layers of vessel
outer to inner
- Tunica Adventitia
- Tunica media
- Tunica Intima
Name the coag factors
- I
- II
- III
- IV
- V
- VII
- VIII
- IX
- X
- XI
- XII
- XIII
- fibrinogen
- Prothrombin
- Tissue factor
- Calcium
- Proaccelerator
- nothing
- Procovertin
- Antihemophiliac factor (and vWf)
- Christmas Factor
- Stuart-power factor
- Plasma thromboplastin
- Hageman factor
- Fibrin-stabalizing factor
Lab Testing:
What is normal PT/INR?
11-12.5 sec
0.8-1.1
Lab Testing:
What pathways does PT/INR measure
both common & Extrensic
Lab Testing:
what factors does PT/INR measure
III, VII (extrensic)
X, V, II,I (common)
Lab Testing:
normal aPTT
30-40 sec
Lab Testing:
what pathways does aPTT monitor
both common and Intrinsic
Lab Testing:
so what factors does aPTT monitor
XII, XI, IX, VIII (INTRENSIC)
X, V, II, I (COMMON)
Lab Testing:
what are normal values for Fibrinogen?
200-400 mg/dL
Lab Testing:
what pathway does fibrinogen monitor
common pathway
Lab Testing:
what factors are monitored w/ fibrinogen
X, V, II, I
Lab Testing:
A fibrinogen level of what is associated w/spontaneous bleeding
< 100 mg/dL
Lab Testing:
what is normal fibrin split products
< 10 mg/L
Lab Testing:
Fibrin split products is a direct indication of what?
direct indication of activity of fibrinolytic activity
Lab Testing:
what is normal Bleeding time
1-9 min
Lab Testing:
what does bleeding time evaluate
platelet function/quality and vascular constriction capability
Lab Testing:
Bleeding time does not provide accurate _____ count
platelet count
Lab Testing:
what is a wider-encompassing test of clot formation, stability, and lysis
Thromboelastography
(TEG)
TEG:
name the main components of the TEG
- Coagulation
- fibrinolysis
- Clotting time
- clot kinetics
- Clot strength
- Lysis time
TEG pic
during the fluid resucitation or massive blood transfusion, that is ___ fluid volume in 24 hrs, or ___ fluid volume in 3 hours, causes coagulation factors and platelets to become significantly diluted
1
1/2
what is the depletion of platelets secondary to markedly increased platelet consumption from coagulation pathway activity?
thrombocytopenia
Thrombocytopenia may lead to microthrombi, resulting in purpura called what?
thrombocytopenic purpura
what can occur if the entire coagulation pathway is activated
DIC
What is platelet levels with DIC for
MILD
MODERATE
SEVERE
- MILD- 70,000-150,000
- MODERATE- 40,000-70,000
- SEVERE- 20,000-40,000
thrombocytopenia:
vascular occlusion by thrombi formation is unusual w/DIC, and the typical manifestation is what?
hemorrhage
thrombocytopenia:
HELLP follows the same pathway as DIC, but is also combined with what?
RBC hemolysis
and
elevated liver enzymes
DIC:
what is the only effective treatment?
treatment of teh underlying cause
DIC:
what is supportive therapy
Plasma and Platelet transfusions
What are 2 types of Autoimmune Coagulopathy
- Posttransfusion Purpura
- Drug induced Autoimmune Thrombocytopenic Purpura
Autoimmune
what causes posttranfusion purpura
Exposure to blood products or some drugs that may induce antibody formation
Autoimmune Coagulopathy:
in DIATP the drugs can act what?
a binding agent for the antibodies to adhere to platelets
Autoimmune Coagulopathy:
Heparin-Induced Thrombocytopenia
What are the 2 types
- Tyoe I- nonimmune HIT- Seen on 1st day of heparim therapy (transient an dclinically insignificant
- Type II- Immune mediated HIT- formation of antibodies to heparin-platelet factor 4 complex
Autoimmune Coagulopathy:
HIT tyoe 2 occurs when
5-10 days after heparin use
and can been seen if heparin therapy is restarted w/in 20 days of previous exposure
Autoimmune Coagulopathy:
Anesthestic management
- Poss platelet transfusion
- D/C precipitating drug
- Hold Warfarin and oral contraceptives
- Delay CV sx
Autoimmune Coagulopathy:
if thrombotic even occurs, administer what?
direct thrombin inhibitor
(argatroban and bivalirudin)
Coagulopathy in SIRS:
this is caused by what?
arises w/ the initiation of the imflammatory responses secondary to infection and decreased blood flow secondary to vasodilation
(AKA coag cascade activated)
Coagulopathy in SIRS:
what is management ?
- keep Hgb 7-9
- FFP for sx
- Keep platelets > 50,000
*
Coagulopathy:
Preop interview
- ? hx of bleeding
- ? hx of bleeding gims w/ dental sx
- ? hx of liver insufficiency or malnutrition
- Coag workup
- Discuss transfusion possibility
